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APPLICATION FOR SANITATION PERMIT Permit No. .. --!-.. I� (Complete in Duplicate) y/ 1 Date Issued ._.__..,41. -S_... ,y Application is hereby made'to the San Joaquin Local Health District for a permit to construct and install the work herein described. 1 This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-..___--- .-7-----• _ / ---------- ----------------------------------------------------------------------- Owner's _ Name�_.�----- -,;�-- -�-�?--�------------ -��*. ---------�-------------------------- ------------- ----- Ph t Address-------- --------- ' __ ----- 1 ' ' - - -- --- --------------•--------------------•----------•-••-- Contractors Name--------- --------------------------- Phone Installation will serve: Resid'e7 Apartm nt House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other El Number of living units: __ Number of bedrooms -._�,- Number of baths .1---- Lot size _ Water Supply: Public system !Z Community system ❑ Private ❑ Depth to Water Table ---- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe I`� Hardpan ❑ Previous Application Made: Yes ❑ NoNew Construction: Yes ❑ No K i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance ''from nearest well_-----Dista a fro fo at1 n__�_0__---____ Material_____ _.. � � �•� - No. of compartments__:.__ Size_ uid de th- ry-• .meq P. Capacity Y__Q----� Dispose Distancefrorn nearest wail-_______________.Distance fr �'5omfRin ___ --._D(Distance nearest lot line______-___..____. Number of lines-------------- ------Length of each line-----------------------------.Width of trench-------------- i Type of filter material-------------------------Depth of filter material-------------.---------Total length_______________------------------------------------------ Seepage Pit: Distance to nearest well-------_--------------Distance from foundation---.---------------.Distance to nearest lot line-------------------- _____.--__._... *«❑ Number of pits----------------------Lining material------. --------------.Size. Diameter-----------------------Depth------------n ------------.-. � 1 Cesspool: Distance e.fe nearest well____ ___Distance from foundation___________________Lining material_.__-_____________-._________.______ V ❑ Size: Diameter- ------------------------------Depth----------------------- .'-,• -------- ------------ ---Liquid Capacity---------- -------------- -gals. Privy: Distance rom nearest well_____-------------------------------------------Distance from nearest building---.______.____---__------- --- ❑ Distance t yo-nearest lot line_______________ ------------ Remodeling and/or repairing (describe):-- ---- �- ------------ --r' , ..--_ J � ---'�-- � - ----•----------•--------------------------------- = r ------------ •----------•--•------•--- ----------------------------- -- ---------•------------------------- ---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San-Joaquin Local Health District. (Signed)_ ---•--- ----------------------------------(Owner and/or Contractor By: :`------------------------l----•------------- ° e Title , - - ---------------------------------------------------------- ot plan, showing size of Iot,'location of system in relation to wells, buildings, etc., can be placed on reverse side). i i k f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-. ------ ------ ----- -- -'-- ==�. - -_------------t-------•------------- DATE rc ----------------- REVIEWED BY --- ------------- -.t- ------------ DATE__ E -- ---- - BUILDING PERMIT ISSUED____a.._,,______.'---- - - -------------•-------------------- - - DATE------------------- Alterations and/or recommendations:.____ __- _- _.- - - ------------------------- �. -- ---------------•--- -------------------------------------------------------------- I-- ----------- --------- ------ ---------... ._ ____:,� _._._PPP FINAL INSPECTION BY:.----"--------------- Date-------------- -------------- -- . - -- ---------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100